Nurses’ Perceptions of Medication Use at the End of Life in an Acute Care Setting

Abstract

Palliative care is frequently part of nursing practice in acute care settings. Research has evaluated nurses' general perceptions on end-of-life care in hospital and identified symptom management as a concern. The aim of this study was to explore nurses' perceptions regarding end-of-life medication use in an acute care setting to enable identification of variables that may impact symptom management and medication use at the end of life. Using a qualitative description methodology, 22 nurses from 8 medical and surgical units participated in 7 focus groups. Nurses were less likely to use medication when having difficulty identifying symptoms and when medications were not familiar. Other factors included conflicting perspectives and the emotional experience. Nurses felt that physicians were often reluctant to involve the palliative care team and experienced delays in obtaining orders or clarifying goals of care. Nurses felt uncomfortable with medication use when their feelings conflicted with family perspectives and found communication with families challenging overall. Nurses expressed a desire to achieve comfort but felt fears surrounding medication use. Fears included hastening death, adverse effects such as depressed respirations, and the possibility of pain pump errors or inappropriate use. Education and resources regarding symptom assessment and common end-of-life medications were identified as important. KEY WORDSacute care, medication administration, nursing, palliative care I t is well recognized that adequate symptom management is a critical component of end-of-life care. Despite this knowledge, it is still common to have unmet symptom needs at the end of life. 1 This problem is most severe in areas that do not specialize in palliative care, particularly in the acute care setting. 2,3 In the hospital setting, health care professionals often do not recognize that a patient is approaching end of life, as the focus has been on active interventions. This may result in missed opportunities to optimize symptom control. As acute care settings tend to focus on cure and active management, transitioning to a palliative care model can be unclear or seen as a failure. 4,5 In general, there is a lack of current research available that focuses on end of life in the acute care setting.The literature does show that families are often dissatisfied with hospital care at the end of life and feel that there is a need for improved symptom control and communication with health care professionals. 6 Both staff and families report that the hospital environment may not be appropriate for end-of-life care because of high levels of noise, busyness, and lack of privacy as well as resource restrictions (eg, staffing levels and time). 6,7 When attempting to address the hospital nurses' perspectives, there is also limited research. The literature has focused on the challenges nurses face with providing endof-life care. Hospital nurses report feeling unprepared and often experience difficulties in meeting the needs of patients and fami...

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“…The assessment of the societal impact of generative AI using videos to support end-of-life care in hospitals encompasses a comprehensive evaluation of ethical, legal, and technical dimensions. Ethically, the use of generative AI in creating videos for end-of-life care necessitates careful consideration to ensure that the content is respectful, empathetic, and aligned with the values and preferences of patients and their families (Bloomer et al 2022;Howes 2015). Moreover, the legal dimension involves scrutiny to ensure compliance with patient privacy regulations, informed consent, and the ethical use of patient data in creating supportive videos for endof-life care in hospital settings (Dunphy et al 2016;Kryworuchko et al 2013).…”

Barriers Faced by Nurses Caring For End-of-Life Patients on a Medical Surgical Unit

“…One critical element of nursing care necessary for patients at end-of-life is ensuring that symptoms associated with dying are managed appropriately. Howes (2015) conducted a study to explore how nurses perceived the administration of end-of-life medications in medical and surgical settings. The purpose of the study was to identify variables that impacted nurses' use of the end-of-life medications in this setting.…”

“…The findings identified four main variables that impacted nurses' use of end-oflife medications when caring for dying patients in the medical-surgical settings. The variables included perceived knowledge and skill, differing perspectives with family members pertaining to use of medication, educational needs to improve knowledge and skills, comfort using end-of-life medications and nurses' emotional experience of taking care of patients at the end of life, which can create a positive or negative outcome (Howes, 2015). Nurses reported that fear related to lack of knowledge and assessment skills was a significant barrier related to the use of medication for symptom management.…”